HANOI NATIONAL UNIVERSITY
UNIVERSITY OF SCIENCESOCIETY AND HUMANITIES
Le Thi Nhung
CASE MANAGEMENT OF PEOPLE WITH DISABILITIES IN THE COMMUNITY IN HO CHI MINH CITY
Major: Social Work
Code: Pilot Training
SUMMARY OF DOCTORAL THESIS IN SOCIAL WORK
Hanoi – 2020
Scientific supervisor: Associate Professor, Dr. Bui Thi Xuan Mai
Assoc.Prof.Dr. Nguyen Thi Thai Lan
Objection 1: ...................................................................................
Objection 2:.....................................................................................
The thesis will be defended before the basic-level Council for evaluating doctoral thesis meeting at
At ............. o'clock, date........... month.............. year...........
Specifically find out the thesis at:
- National Library of Vietnam
- Information Center - Library, Vietnam National University, Hanoi
INTRODUCTION
1. Reason for choosing the topic
Among vulnerable groups, the number of people with disabilities accounts for a large proportion and tends to increase rapidly in the world and in Vietnam. The community of people with disabilities (PWD) is up to one billion people, accounting for more than 15.3% of the world's population [WHO, WB, 2011, p.29], of which 80% of PWD live in developing countries [United Nations, 2006]. According to the results of the national survey on PWD by the General Statistics Office, Vietnam has more than 7% of the population aged 2 and over - about more than 6.2 million people with PWD [General Statistics Office, 2018, p.15]. The total number of PWD in Ho Chi Minh City as of July 2019 is 62,554 people [Ho Chi Minh City Department of Labor, Invalids and Social Affairs, 2019]. People with disabilities are one of the most vulnerable and disadvantaged groups in the context that they face many difficulties in all aspects of life [WHO, 2010, p.9].
In recent years, the Party and the State have paid more attention to PWDs in order to create the best conditions for them to gradually develop comprehensively and integrate into the community. In 2019, 03 amended and supplemented laws were passed, including regulations to protect the rights of PWDs and many sub-law documents of the Government, ministries, departments, and branches, especially the Central Executive Committee of the Party with Directive No. 39-CT/TW of the Secretariat on strengthening the Party's leadership over PWDs' work [Lan Phuong, 2019].
However, a relatively small number of PWDs have access to and benefit from policies from the State. The whole country has only 1.3 million PWDs who have been granted disability certificates [Ministry of Labor, Invalids and Social Affairs, 2016], which means that a relatively modest proportion of PWDs are officially enjoying preferential policies from the State. In Ho Chi Minh City, subjects (about 1% of the total number of PWDs) living in social protection facilities have relatively full access to policies and support programs from the State, but in general, it is still at a low level. In another study, in the provinces, only 20% of respondents have the need for centralized care and nurturing, so the majority of PWDs want to live in the community and support themselves [Department of Social Affairs, Institute of Labor Science and Social Affairs, 2012]. The majority of PWDs living in the community, especially those who have not been certified as PWDs, do not have many opportunities to access government support policies or professional services in the community. The need for assistance is quite large, reaching nearly 100% [Department of Social Affairs, Institute of Labor Science and Social Affairs, 2012].
World experience shows that social work (CSW) plays an important role in assisting vulnerable groups in society in general and PWDs in particular. Based on the core values of the profession and in compliance with ethical codes, social workers use their knowledge and skills to perform various roles and tasks for each individual, family, and community [IFSW, IASSW, 2014]. In CSW, case management (CM) is one of the important and popular operations and methods used in assisting PWDs with community-based rehabilitation at the individual level, helping to access social policies, enhance independent living, increase capacity and social integration. QLTH to serve clients with different needs and a comprehensive package of services [Rose & Moore, 1995], helping clients receive the best care and save costs [CMSA, 2016, p.87]. As funding for education, health, housing, and even social services shrinks, service coordination (referral linkage) is used as a strategy to improve service quality and outcomes while reducing costs [Brown, 2009; Centers for Medicare & Medicaid Services, 2011].
After 10 years, Project 32 of the Vietnamese Government on the development of social work profession in the period of 2010-2020 has achieved many initial achievements in promoting the role of social work to solve social problems and assist vulnerable groups, including PWDs. However, social work management for PWDs is still quite new in Vietnam. The Ministry of Labor, Invalids and Social Affairs has initially standardized and guided social work management according to Circular No. 01/2015/TT-BLDTBXH dated January 6, 2015. Social work management has been initially applied in some state-owned facilities. Social work management for PWDs only meets the minimum needs in nurturing, caring, educating and rehabilitating PWDs. Some non-public social protection facilities have had previous approaches, although they have not been officially called social work management, but are still entangled in other mechanisms. In Ho Chi Minh City, with a large number of PWDs living mainly in the community, they will mainly rely on the community in which they need to manage their cases to access services and assistance. Up to now, management of cases has not been widely developed in the community due to the lack of professional staff, poor utilization of local resources, and limited awareness of PWDs themselves, their families and the community about the rights of PWDs. The role of social workers in management of cases is unclear and unprofessional. There are very few studies with evidence and evaluations in case management with PWDs in the community.
Based on the above reasons, the author chose to study “Case management with people with disabilities in the community in Ho Chi Minh City.”
2. Research purpose and tasks
Research purpose
The thesis aims to evaluate the current status of case management with people with disabilities in the community, analyze influencing factors, and thereby propose solutions to promote professionalization of case management with people with disabilities in the community.
Research mission
3. Subject, object and scope of research
Research object: Case management with people with disabilities in the community.
Research object:
- QLTH staff with NKT as self-assessment implementers
- PWD and family members/primary caregivers of PWD
- Leadership and management of social assistance facilities
- Leaders and managers at all levels in the Labor, Invalids and Social Affairs sector
Scope of research
Range ofContent
Based on ecological system theory, social role theory and community-based rehabilitation approach, the topic focuses on studying case management in social work, specifically the implementation of roles, processes and tasks of case management staff and some factors that strongly influence case management with PWDs in the community.
Scopeabout research object
The survey participants are cadres, employees, and collaborators in managing PWDs at the People's Committees of communes and wards, and at facilities, centers, and organizations supporting PWDs in the community. In addition, PWDs participating in in-depth interviews include PWDs with mobility and visual disabilities aged 18 to 60 years old. For autistic children, family representatives/primary caregivers will answer in-depth interviews. Stakeholders include leaders of support centers/facilities, local managers, ministry-level managers, Departments of Labor, Invalids and Social Affairs, and district-level officials in charge of Labor, Invalids and Social Affairs.
Range of spacen:The study was conducted in 23/24 districts in Ho Chi Minh City.
Time range:From 2015-2020
4.Research question
5. Hypothesisstudy
5.1. Case management for people with disabilities in the community is still quite limited and unprofessional.
5.2. QLTH staff encountered some difficulties and challenges in implementing QLTH with PWDs in the community.
5.3. There are a number of factors that strongly influence case management with PWDs in the community.
5.4. Training to improve the capacity of case management staff is one of the solutions to help improve case management with people with disabilities in the community.
6. Meaningand new contributions of the Thesis
In theory:The research results of the thesis provide a theoretical basis system on case management with the characteristics, roles, processes and tasks of case management staff with people with disabilities in the community from the perspective of social work. These concepts and tools contribute to building theories to consolidate case management as an effective social work practice in working with people with disabilities. The research is also a source of reference for future studies on the field of case management in social work.
In practice:The practical research results of the thesis help managers and employees identify and recognize the roles, processes and specific tasks to implement social work management with PWDs in the community according to the principles and core values of the social work profession; at the same time, verify the practice of staff and employees self-assessment and customer feedback in implementation, barriers and difficulties in social work management with PWDs in the community context as well as explore flexible and effective implementation methods at the local level.
In terms of training:The system of theoretical foundations and practical research results helps training institutions orientate towards specialized training in community-based management of PWDs, while also detecting practical needs and gaps in the expertise of practitioners to design and organize training programs and improve capacity more appropriately for the team of community-based management staff who are working and intending to work with PWDs.
In terms of policy:Based on international experience and the actual implementation of policies, programs and services at the local level, the thesis helps policy makers have scientific bases to develop and adjust more appropriate policies to support PWDs in the community.
Thesis Outline
In addition to the Introduction, Conclusion and Recommendations, References, Appendix, the thesis content is presented in 4 chapters: Overview of the research problem; Theoretical basis and research methods; Current status of community-based management of PWDs in Ho Chi Minh City: Training solutions to improve capacity for the team implementing community-based management of PWDs.
MAIN CONTENT
1. OVERVIEW OF THE RESEARCH PROBLEM
1.1. Studies on case management and case management in social work
Case management is applied in the world not only in the social work sector but also in other sectors. From the perspective of social work, case management was first studied as a method of assistance focusing on individuals [Richmond, 1917] through individual assessment activities on poverty status, coordination activities, networking, registration. In Vietnam, a number of studies supported by international organizations to pilot case management in assisting some target groups such as abused children, children in difficult circumstances (affected by HIV/AIDS, poor families) or drug users showed the suitability and modeled organizational structure of the implementation team, the way to organize intervention activities, assistance services in the specific context of Vietnam. However, there are some gaps in research evaluating practical implementation at the local level, especially in the field of PWD.
1.2. Studies on the roles of case management with people with disabilities in the community
Theoretical and practical studies on case management in the world show that case management plays an important role, as a social work practice that brings positive effects in assisting PWDs. In addition, studies in other countries have clarified and affirmed the role of case management staff trained in social work in teams and cooperative groups as coordinators, connectors, referrals, resource mobilisers, facilitating increased access for clients as well as providing direct services in consultation, education, and advocacy. However, there are very few practical studies in Vietnam on the position and role of case management with PWDs in general, and the specific roles of case management staff in assisting PWDs in the community in particular.
1.3. Studies on the process and tasks of case management with people with disabilities in the community
Some studies have mentioned the process and tasks of managing people with disabilities, focusing on needs assessment, care planning, assistance and monitoring/evaluation. In the context of Vietnam, there are some research documents reflecting the tasks of managing people with disabilities that need to be carried out according to a social work process. However, even in the world, there is a lack of practical evaluation studies on the process and specific tasks of managing people with disabilities in the community in particular. Studies in Vietnam also stop at the level of providing theoretical and theoretical basis.
1.4. Studies on models of supporting people with disabilities in the community
Studies in the world and in Vietnam show that there are main models of supporting PWDs including: spiritual model, medical model, social model, rights-based model. Regarding research projects on models of supporting PWDs in the community, there are 3 main groups of models and approaches, including: standard care model in the community, comprehensive intensive care model and community-based rehabilitation model. In which, the community-based rehabilitation model demonstrates superiority, progress and is the trend of supporting PWDs in the world.
1.5. Studies on factors affecting case management with people with disabilities in the community
Some domestic and international works show the factors affecting the quality of care for people with disabilities from the quality management staff, specifically professional qualifications, knowledge, skills, from the quality management staff are the characteristics of the poor, the individual efforts of the poor, customer motivation and perseverance, from the family and community are attitudes and participation as support resources, from the service provider are the basic capacity, network capacity as well as the awareness of the leaders, from the policy system is the issue of whether the poor are properly concerned and supported. However, there are quite a few studies on the factors affecting the quality of care for people with disabilities in the community context as well as the approach is to recognize the negative factors rather than to find out the positive factors.
CHAPTER 2: THEORETICAL BASIS AND RESEARCH METHODOLOGY
2.1. Concepts related to the research problem
2.1.1.People with disabilities
In this part, the thesis deals with the concept of PWD, the physical, psychological, emotional and social characteristics of PWD, the causes from a medical perspective, the barriers in the physical and social environment leading to disability, and the need for assistance to meet basic needs.
“A person with disabilities is a person who has a defect in one or more body parts or a functional impairment manifested in the form of a disability that makes it difficult for them to work, live, study and participate in social life.” [National Assembly of the Socialist Republic of Vietnam, Session XII, 2010]
2.1.2.Case management in social work
Case management in social work is understood as a process of planning, searching, advocating and monitoring services provided by social services, health care organizations and various staff for a client [NASW, 2013, p.13].
Case management has goals, characteristics, processes, and tasks, as well as sets out requirements for the professional competence of the practitioner.
2.1.3. Case management with people with disabilities in the community
Concept:Case management with PWDs in the community is a process of implementing social work practices based on building therapeutic professional relationships, collecting information, assessing needs, strengths, prioritizing assistance to provide, connect, coordinate and mobilize services, assistance in the community with the participation of PWDs and community systems to maximize the condition and perform the functions of PWDs towards community integration.
Target:QLTH aims at the main goals of supporting PWDs in the community to i) access necessary information, services, resources, appropriate, effective and timely assistance; ii) participate and make decisions to the maximum extent.
Cevil characteristics:Services are client/client-centered; The occupational therapy relationship between staff and client/client is fundamental; Person in environment is fundamental; Strengths-based; Team collaboration; Interventions at micro, meso and macro levels
Processincludes 6 steps: Step 1 - Receiving cases and building relationships with people with disabilities; Step 2 - Collecting information and assessing the needs of people with disabilities; Step 3 - Developing a plan to care for and assist people with disabilities; 4 - Implementing the plan to care for and assist people with disabilities; Step 5 - Monitoring, supervising, and evaluating services and assistance; Step 6 - Closing and following up after the case.
Main tasksof the occupational therapy staff include: Receiving cases and building occupational therapy relationships with people with disabilities; Collecting information and assessing the priorities for assistance, strengths and barriers of people with disabilities; Developing a care and assistance plan for people with disabilities; Implementing the care and assistance plan for people with disabilities; Monitoring, supervising and evaluating services and assistance; Closing and following up after cases; Related administrative tasks.
TheroleThe core roles of the QMS staff include: connecting, coordinating, mobilizing resources, and facilitating. In addition, there are other roles such as consulting, educating, and advocating.
Cprofessional competence requirements ofQLTH staff
Community-based management staff for people with disabilities are understood to be those who work directly with people with disabilities in the community and perform specialized tasks in community-based management for people with disabilities.
Requirements include: Specialized knowledge related to community-based management of people with disabilities, knowledge of community-based management tasks and processes, skills in community-based management of people with disabilities, and professional ethics in community-based management of people with disabilities.
2.1.4. Factors affecting the quality of care for people with disabilities in the community
The groups of influencing factors focused on research include:
-Professional competence of QLTH staff: Have professional qualifications in social work; Have knowledge related to management of people with disabilities; Have skills in management of people with disabilities; Comply with professional ethics and principles in management of people with disabilities; Understand people with disabilities.
- Strengths and abilities of the disabled:Understanding one's own rights; Identifying one's own strengths; Having will and motivation; Actively participating in cooperation.
- Awareness and participation of family and community:i) On the family side: Understanding the rights of PWDs, being responsible for PWDs; Proactively participating and cooperating with staff; Having the capacity to care for and assist PWDs at home; Understanding legal policies, programs, and assistance resources; ii) On the community side: Understanding the rights of PWDs; Proactively fulfilling responsibilities towards PWDs; Actively participating as a resource for assistance; Creating conditions for PWDs to participate in community life.
- Legal policy:Full social security policy for the implementation team; Full support policy for PWD; Diverse programs and services according to the needs of PWD; Specific policies on the position, role, responsibility, and coordination mechanism of the implementation team; Specific instructions, with support tools; Sanctions and incentives in the implementation of services by the implementation team.
- Support facilities and units: i) On the part of the leadership: The awareness and concern of the leadership include: Understanding and responsibility for implementing the rights of the disabled; Understanding of the management of the disabled; Prioritizing the needs of the disabled; Commitment in directing the implementation and regular evaluation of the management of the disabled; ii) Service capacity and staff: Having enough professionally trained staff in the management of the disabled; Having the capacity to connect and have a network of cooperation and referral; Having the capacity to mobilize local resources.
2.2. Theories used in the topic
Theories include 02 theories (ecological system theory, social role theory) and 01 approach (community-based rehabilitation) applied in building instrumental concepts of community-based management of PWDs in the context of Vietnam as well as the research framework of the Thesis.
2.3. Methods of information collection and processing
The thesis used a combination of quantitative and qualitative research methods based on both primary and secondary data sources including research methods and synthesis of available documents, expert consultation, survey by questionnaire, in-depth interviews, group discussions, impact experiments, and case studies. The data and information obtained were processed with different methods such as quantitative data and information processed with Excel, SPSS software and qualitative data and information from in-depth interviews, group discussions were processed according to coding of topics suitable for the research.
In which, the main information collection methods include: questionnaire survey, in-depth interview, group discussion, impact experiment, case study.
Questionnaire survey method
The questionnaire was conducted with the staff/employees of the People's Committee, public and non-public facilities implementing the management of people with disabilities in the community.
Step 1- Test Investigation: The questionnaire was tested and analyzed with 84 questionnaires that met the analysis conditions. The reliability results of the scales in the questionnaire had Cronbach's Alpha coefficients from 0.674 to 0.804.
Step 2- Design the questionnaire
Main content of the questionnaire:The questionnaire is structured into 4 parts including general information about occupation and demographics; Current status of implementation of roles, tasks, and activities in the process of managing people with disabilities; Training needs to improve capacity; Proposed solutions.
Scale:The survey was designed with Likert scales with 05 levels (Vagias, Wade M., 2006) on the level of agreement, level of implementation, level of influence, and level of necessity.
Step 3- Select survey template
Size of the sampleBased on the requirements of exploratory factor analysis EFA (Exploratory Factor Analysis):n = 5 x m(m is the total number of observed variables, expressed as the number of questions in the model) [Comrey, 1973; Roger, 2006]. With m = 30, the required sample size =150.
Select snowball template: The list is from diverse sources, compiled and introduced from state management units, social worker networks, leaders of social assistance facilities working with PWDs, students and former students of the University of Labor and Social Affairs (CSII) who are also officers and employees in localities, etc. Then, a survey is conducted, including the next people based on the introduction of the previous person.
Step 4- Implementation:Online survey and questionnaire survey.
The total number of votes eligible for analysis is374questionnaire, meeting the requirements for sample size to have statistical significance in sociological investigation.
Some characteristics of the research object (N = 374):
- Type of working unit (A1): Department under the People's Committee (72.5%), Public unit (18.4%), Non-public unit (9.1%)
- Location (A2): 23/24 districts
- Current job position (A3): Social work collaborator (29.7%), social work/social affairs officer/staff (34.5%), labor, war invalids and social affairs officer/staff (33.2%), other jobs (coordinator, project staff, homeroom teacher,...account for 2.7%)
- Social work expertise (A4): None (31.8%), have taken short-term courses (39%), have primary level/vocational certificate (4.3%), have intermediate level (12.3%), have university level (11.8%), have postgraduate level (0.8%)
- Trained in QMS (A5): No (62.3%), took a course of less than 1 week (14.2%), took a course of 1-2 weeks (7.5%), took a course of 3-4 weeks (9.6%), had a primary level/vocational certificate (6.4%).
- Managing multiple groups of subjects or holding other jobs: Yes (85.6%), No (14.4%)
- Number of people managed by PWD: Less than 10 people (24.6%), 10-20 people (3.5%), 21-30 people (16.8%), 31-40 people (16.6%), over 50 people (38.5%).
In-depth interview method
In order to analyze, explain, supplement or compare the survey results using questionnaires, in-depth interviews were used with 04 related target groups: QLTH staff (06 people); PWD (visually impaired, mobility impaired and autistic) and family members/primary caregivers (08 people); Managers at all levels in the Department of Labor, Invalids and Social Affairs and locality (04 people); Leaders and managers of social assistance facilities (04 people).
How to do it:The QLTH staff are the ones selected based on the survey results to exploit the information more deeply. The interviewees representing each target group are selected to represent the district and county area. The PVS process is carried out with the consent and voluntariness of the interviewees in the notes and recording. The interviewers use the instruction sheet (Appendix form No. 02, 03, 04, 05 for each target group) to conduct the PVS, in addition, other small questions are given or the way of asking and the number of questions are adjusted to explore the content and follow the progress of the interviewees.
Group discussion
After analyzing the preliminary survey results, group discussions with the case management staff who also participated in the survey were conducted to analyze and explain in more depth the current situation of case management implementation with PWDs in the community. Number of groups: 04 groups (each group of 6-8 case management staff, total of 29 people); Discussion time: 50 minutes; Topic: Advantages, difficulties, and obstacles in the process of implementing case management with PWDs in the local community and proposed solutions to overcome them.
How to do it:The members were those who had previously completed the questionnaire. The researcher acted as an observer and took notes of the progress. Each group had a facilitator (a previously trained person) to guide and support the discussion group.
Impact experiment
Based on the results of the training needs survey, the study conducted a training course to improve the capacity of staff and managers of the community with PWDs.
Activity 1: Organize an intensive training course on case management with people with disabilities in the community(10 sessions, 4 hours each session)
Number of participants:30 officers and employees working with people with disabilities at units under the Ward People's Committee, public units and non-public units.
Content:The training course focuses on 04 groups of topics related to community-based management of people with disabilities, selecting the most important and core contents in the block of specialized knowledge, processes, skills, professional ethics, and implementation principles in community-based management of people with disabilities.
Impact measurement method:Participants were surveyed about their level of understanding and confidence in practice before and after the training with the same survey form.
Activity 2: Post-training guidance/inspection(6 months)
Form:On-site guidance, remote exchange and professional consultation.
Quantity:02 people (01 officer at the Ward People's Committee, 01 employee at the social assistance facility). Both employees participate in community-based management activities with PWDs.
Impact measurement method:Observe cases of administrative tasks such as recording, archiving and managing records, how to perform roles, tasks and interact with clients during the case management process.
2.3.7. Case study method
The case study method was applied at 03 facilities providing services to PWDs to have in-depth analysis of the current status of records, implementation of roles and tasks, activities in QLTH as well as to learn about good and flexible experience models as well as explain some survey results. In addition, the study was also conducted with 02 QLTH staff (01 officer at the Ward People's Committee, 01 officer at the social assistance center) to observe the positive changes after the impact experiment.
CHAPTER 3. CURRENT STATE OF CASE MANAGEMENT
WITH DISABILITIES IN THE COMMUNITY
HO CHI MINH CITY
3.1. General situation of people with disabilities and related policies and services in Ho Chi Minh City
- As of July 2019, the total number of PWDs in the city was 62,554 people. Practical studies by a number of authors show that PWDs need assistance in all aspects of life from monthly support money, health insurance, medical examination and treatment, policy advice, services, assistance procedures, resources, health care advice, equipment support, capital support, production and business advice, vocational training, cultural learning, vocational training, life skills, social needs such as participating in social groups, recreational activities, counseling, psychological counseling, legal advice, part-time care services, day care, full-time home caregivers, centralized care... requiring a system of diverse programs and services to meet.
- In the period of 2014 - 2020, the City also has a number of programs focusing on supporting PWDs in employment, healthcare, access to public facilities, legal aid, poverty reduction and social security. According to the report of the Department of Labor, Invalids and Social Affairs of Ho Chi Minh City, there are still many limitations in supporting PWDs in practice. The City also has a diverse network of public facilities to support different target groups. However, the number and accessibility of PWDs in the community to such facilities, support units and programs is still an open gap that has not been assessed.
- Regarding the team implementing social work services, there are currently about 5,000 people in the People's Committee system at all levels, public and non-public facilities, mass organizations... The big challenge of Ho Chi Minh City is the regulation on streamlining the payroll while the responsibilities, pressure of many tasks and the number of beneficiaries are large. According to the author's survey, 31.8% of the staff managing the case with PWDs in the community have not been trained in social work, 62.3% have not received specialized training in social work management. Up to 82.6% manage many groups of beneficiaries or hold other jobs concurrently.
3.2. Current status of case management implementation for people with disabilities in the community
3.2.1. Current status of implementing the roles of case managers with people with disabilities in the community
The roles of QLTH staff were rarely or rarely performed (Consultation, Average = 1.84; Advocacy, Average = 1.88; Coordination, Average = 1.94; Education, Average = 1.96; Facilitation, Average = 2.15; Connection, Average = 2.38). Only the resource mobilization role was performed by staff at a moderate level with the highest Average = 2.88.
3.2.2. Current status of staff implementing the process and tasks of case management with people with disabilities in the community
Most of the tasks in the steps of the QMS process are being performed at a low level of frequency (Receiving cases and building relationships with people with disabilities, DTB= 2.07; Collecting information and assessing the needs of people with disabilities, DTB= 2.45; Developing a plan for care and assistance for people with disabilities, DTB= 2.21; Implementing a plan for care and assistance for people with disabilities, DTB= 2.07; Especially Monitoring, supervising, and evaluating services and assistance has the lowest level of implementation, DTB= 1.96; Closing and monitoring after the case, DTB= 2.2).
In addition to the task of creating case files with initial information (essentially a disability assessment file and later a list of benefits) which was performed at a normal level (Average = 2.71), other administrative tasks stopped at a low or rarely performed level (Using tools and forms in the process had the lowest Average = 1.81; Recording information and progress, Average = 2.12; Archiving, Average = 2.38; Periodic reporting of results, Average = 2.38; Sharing information with consensus, Average = 2.41; Securing records and information, Average = 2.57).
The general overview of the process of managing people with disabilities in the community in the People's Committee system at all levels is as follows:
|
The Ward People's Committee collects information and establishes profiles of PWDs, surveys and assesses the needs of PWDs. Then the Ward People's Committee establishes profiles and sends them to the District Department of Labor, Invalids and Social Affairs. Based on the profile criteria as prescribed, the Department of Labor, Invalids and Social Affairs submits to the District People's Committee a decision on the subsidy regime. Every month, the management on the list approved for subsidy, the Department of Labor, Invalids and Social Affairs prints it out and sends it to the Ward for signature and distribution. If PWDs are in difficulty, the staff will go to their homes to distribute it. In actual work, there is inspection and supervision, normally divided by quarter, during which time the Ward is assigned to manage and update income information, information, and circumstances of work and living place... At the end of the year, the District/County sends an inspection and supervision team, mainly on the list and subsidy payment regime. In the Ward, commune, and town, there is a specialized Labor, Invalids and Social Affairs officer (usually a Social Affairs officer), who manages many subjects, concurrently holding the position of subjects including PWDs. In residential groups and villages, there are support staff. Staff can be group leaders, staff in charge of poverty reduction, children and population... there is no clear position for staff in charge of PWDs. At the district level, there is 01 social worker in charge of general policies for target groups. Up to now, Ho Chi Minh City has not had a position to identify social workers, social workers or social workers. |
3.2.3. Correlation testing in case management implementation with people with disabilities in the community
The data analysis results show that the progress of the steps is closely correlated with each other, reaching values from 0.543 to 0.683 at a confidence level of up to 99%.
3.3. Factors affecting case management with people with disabilities in the community
3.3.1. Testing the factor rotation matrix of the influencing factors model
Factors affecting the quality of life of people with disabilities in the community have Cronbach Alpha ranging from (0.717 to 0.831) ≥ 0.6, the adjusted variable-total correlation coefficients of the observed variables all meet the requirements (≥ 0.3), so all 30 component variables are eligible to be included in the EFA analysis.
KMO coefficient = 0.859> 0.5. Bartlett test: Meets requirements (Sig = 0.000 < 0.05). Eigenvalues: Stops at the number of factors of 5. The influencing factors form a model with 05 groups of influencing factors with 29 observed variables meeting the requirements, only the variable (facility, support unit with the capacity to mobilize resources) is eliminated from the model, loading factor < 0.05.
The model of 5 groups of influencing factors was discovered based on the self-assessment of the QTH staff, including: Strengths and abilities of the disabled; Awareness and participation of family and community; Legal policies; Support facilities and units; Professional capacity of the QTH staff.
3.3.2. Group of factors affecting the strengths and abilities of people with disabilities
Factors related to the strengths and abilities of PWDs are assessed at strong and very strong levels of influence (Recognizing one's own strengths, Average = 4.07; Having will and motivation, Average = 4.08; Understanding one's own rights, Average = 4.18; Actively participating in cooperation has the highest level of influence, Average = 4.24).
3.3.3. Group of factors on awareness, family and community participation
On the family side, the factors that are assessed to have a strong influence include: Ability to care for and support PWDs at home, Average = 3.90; Understanding of legal policies, programs, and support resources (Average = 4.07); Understanding of PWDs' rights and responsibility for PWDs, Average = 4.12; Proactively participating and cooperating with staff, Average = 4.07.
On the community side, the factors that have strong influence include: Creating conditions for PWDs to participate in community life, Average = 3.74; Proactively fulfilling responsibilities towards PWDs, Average = 4.02; Understanding the rights of PWDs, Average = 4.03; Actively participating as a source of assistance, Average = 4.06.
3.3.4. Group of factors influencing legal policies
Factors assessed at a strong level of influence include: Specific instructions, support tools, DTB= 3.70; Diverse programs and services according to the needs of PWDs, DTB= 3.76; There are sanctions and incentives in the work of the implementation team, DTB= 3.88; Full support policies for PWDs, DTB= 396; Specific policies on positions, roles, responsibilities, and coordination mechanisms of the implementation team, DTB= 3.98; Full social security policies for the implementation team, DTB= 4.16
3.3.5. Group of factors on supporting facilities and units
- Factors assessed at a very strong level of influence include: The facility has enough staff professionally trained in managing people with disabilities, DTB= 4.21; Leaders prioritize meeting the needs of people with disabilities, DTB= 4.33; Leaders have knowledge of managing people with disabilities, DTB= 4.36
- Factors assessed at a strong level of influence include: Leaders are committed to directing the implementation and regular assessment of the work of quality management, DTB= 3.86; Leaders understand and are responsible for implementing the rights of people with disabilities, DTB= 3.97; Facilities have the capacity to connect and have a network of cooperation and referral, DTB= 3.99.
3.3.6. Group of factors on professional competence of case managers
According to subjective assessment, the QMS staff believe that the professional capacity factors that strongly influence the QMS with PWDs in the community include: Compliance with professional ethics and principles in QMS with PWDs, Average = 3.65; Having professional qualifications in social work, Average = 3.75; Understanding of PWDs, Average = 3.79; Having skills in QMS with PWDs, Average = 3.95; especially having knowledge related to QMS with PWDs has the strongest influence, Average = 4.02.
Correlation testing of professional and occupational factors and implementation of employee quality management
Career factors
- The type of unit (A1) the employee is working in also has a positive correlation with the level of employee role implementation (r = 0.151) and the QMS process (r = .149) at a significance level of 99%.
- The number of staff assigned to be in charge (A7) is negatively correlated with the level of implementation of roles and the QMS process with negative correlation coefficients of r = 0.119 and r = 0.109 respectively at a significance level of 95%.
Professional factors
- The factor of being trained in quality management (A5) has the strongest impact with a positive correlation coefficient on the level of employees performing roles (TBC1, r= 0.394) and quality management process (TBC2, r= 0.374) at a significance level of up to 99%.
- The factor of social work training (A4) also has a positive correlation with the performance of roles and the implementation of the human resource management process of employees with coefficients r of 0.177 and 0.15 respectively at a significance level of up to 99%.
CHAPTER 4. TRAINING SOLUTIONS TO IMPROVE THE CAPACITY OF THE TEAM IMPLEMENTING CASE MANAGEMENT FOR PEOPLE WITH DISABILITIES
4.1. Need for capacity building training
All knowledge blocks are assessed at the level of absolute necessity, specifically as follows:
- The survey respondents assessed that the specialized knowledge block related to community-based management of PWDs (G11-G18) had a fairly diverse GPA (4.32 ≤ µ ≤ 4.76), in which knowledge about evidence-based practice models (G16) had the highest GPA (µ = 4.76).
- The knowledge block on tasks according to the process of QLTH with NKT (G19- G115) is assessed at a relatively equal level of absolute necessity (4.47 ≤ µ ≤ 4.71). Monitoring, supervision, and evaluation (G113) is assessed as the most necessary (µ = 4.71).
- The knowledge block of skills (G116- G121) is assessed as completely necessary at the GPA levels and is also quite diverse (4.31 ≤ µ ≤ 4.75), the skills of linking/connecting, coordinating, and transferring (G118) are assessed the highest (µ= 4.75)
- Regarding knowledge related to attitudes, professional ethics, and principles when working with PWDs (G122), it is also considered completely necessary (µ= 4.23).
4.1.2. Training level
The training level needs of the respondents varied from short-term supplementary courses to professional training levels. Of these, 1-2 week courses were the most popular choice, with more than half of the respondents (50.9%).
4.1.3. Training time
In the timetable, the respondents wanted the class to be held on weekends with the highest percentage (75%), followed by choosing weekdays, in 1-3 day sessions (63.7%).
4.1.4. Training form
Nearly 82% of respondents chose traditional, classroom-based training, while 81% chose on-site, instructor-led training.
4.2. Impact Experimental Program
Theoretical basis: Based on educational principles of the relationship between knowledge, skills and attitudes [UNESCO, 2014]
Practical basis:Based on the survey results on the implementation of the roles, processes and tasks of the QMS staff in the community with PWDs, there are still many limitations. The influencing factors also show that professional training in social work and QMS is closely correlated with the implementation of the QMS staff.
4.3. Experimental results
4.3.1. Results before and after training
Measurement of understanding level and confidence level in implementation showed a clear change in results after training, specifically as follows:
Roles staff play in the process of managing people with disabilities in the community
- The understanding of all roles has increased significantly with the GPA ranging from 3.67 to 3.80, rated at the good/know level. The increase is from 0.63 to 1 point, the facilitating role has the highest increase.
- The level of confidence in performing the roles also improved significantly. All roles were assessed at an average level ranging from 3.50 to 3.63, at a level of being quite confident in performing them on their own. The increase was from 0.74 to 0.97 points, in which the facilitating role also had the most obvious improvement.
Tasks in the process of managing people with disabilities in the community
- Participants' understanding of the tasks of quality management has clearly changed positively, the average score ranges from 3.73 to 3.93, assessed at the level of knowing well. The increase is from 0.86 to 1.03 points, in which the task of implementing the care and assistance plan has the most improvement.
- The average score for confidence in performing tasks ranged from 3.60 to 3.83, at a fairly confident level to perform on their own. The increase ranged from 0.87 to 1.13 points, in which the task of developing a care and assistance plan had the clearest improvement.
Skills in case management with people with disabilities in the community
- The level of understanding in all skills was self-assessed at a good level, with the GPA ranging from 3.77 to 3.87. The increase was from 1.06 to 1.17 points, in which the skills of connecting, transferring, coordinating services and resources had the most obvious improvement.
- The participants' confidence changed very positively with the GPA ranging from 3.73 to 3.80, at quite confident in self-implementation. The increase was from 1.01 to 1.22 points, in which the skills of recording, reporting and storing (using forms) had the most obvious change.
The post-test results also showed a significant reduction in standard deviations across all dimensions. This suggests that the differences between participants in their levels of knowledge and confidence have decreased, meaning there is greater homogeneity among participants.
4.3.2. Case observation results
The measures of guidance and personal supervision after training create changes in the QLTH staff in actual operations as follows:
Case 1(Male, 36 years old, social worker)
- Have a separate book to track each case, make additional notes about other client needs, start cross-assessment and collect information from more sources.
- Apply more systematically and deliberately when using relationship building skills with clients in each communication situation.
- Carry out specific activities with more roles than before: Educator, resource mobilizer, personal supporter, networker.
- Change in thinking about service provision: The idea of a paid service sector for people with disabilities who can afford it.
Second case(Female, 26 years old, homeroom teacher for autistic children)
Observing the process of the QLTH staff working with a new disabled child at the Center (November 2019 - April 2020), the staff made some progress as follows:
- Step 1 (receiving cases and building occupational therapy relationships with PWDs and their families): Have ways to talk and communicate to create a friendly atmosphere by smiling, expressing concern and empathy for children and their families.
- Step 2 (collect information and assess the needs of care and support for people with disabilities): Use listening skills and get information from many sides, not only the student's profile but also meet the student, family, relevant parties, visit the family's place of residence, fill out information forms, create a client profile and save the profile information receipt form.
- Step 3 (develop a care and support plan): Together with the remaining teachers, discuss with the family to agree on activities and responsibilities of all parties to develop weekly and monthly plans.
- Step 4 (implementing the care and support plan): Work with teachers to organize intervention and support activities for children from a personal perspective, with the participation of other members of the group and other departments in teaching culture, care, health check-ups, therapy for children, consultation for children and families, and communication in the community.
- Step 5 (monitoring, evaluating, evaluating): Each month, together with the remaining teachers, we will evaluate what has been done and what has not been completed, discuss with the manager (Center leader), the children's families and adjust the plan accordingly.
- Due to the 6-month observation period, there are no observation results at step 6 (end and follow-up of the case).
CONCLUSION AND RECOMMENDATIONS
1. Conclusion
People with disabilities are a group of subjects, customers with their own physiological, psychological, emotional, and social characteristics. Each individual has different needs, different needs for assistance, so there needs to be services and support suitable for each individual. Research shows that case management, especially case management in social work, is an effective and suitable method of operation to comprehensively manage all support services for a specific customer when they have many needs. The overall research shows that with the roles and tasks in the case management process, case management staff can meet the needs of assisting people with disabilities in the community.
In Vietnam, case management with PWDs has been institutionalized by State regulations since 2015 and has recently been guided to be applied to all target groups. Research on case management with PWDs in the community in Ho Chi Minh City shows that the implementation process of case management staff with PWDs in the community has some good models and methods but also has certain limitations. Regarding the roles that demonstrate social work expertise, case management staff have partly performed the role of resource mobilization and have some good ways of mobilizing resources from natural networks (family, neighbors, etc.) and experts. Staff have also performed the role of facilitating PWDs to access some support policies. However, some core roles of case management such as connector, coordinator, and facilitator of participation in social life and the community are still quite vague. Or educational or consulting roles, which are also common roles of QLTH staff, are less often performed.
The study shows that the QMS staff have partly performed some tasks and activities in the QMS process with PWDs such as making payment records, collecting some information about disability, health, education, livelihood, employment or supporting PWDs with some social policies or supporting participation in some events of the Festival and Tet. However, the professional tasks and activities of QMS have not been as expected, and are rarely performed such as building relationships with clients, collecting information and assessing needs, especially needs in terms of social aspects, relationships, psychology, emotions, and life skills. Planning and implementing plans are still very infrequent. Inspection and supervision work is mainly on the list of eligible people and payment regimes. The steps and tasks in the process are closely related to each other. When steps and tasks are not performed well at a certain stage, it will affect the remaining steps in the quality management process.
The implementation of roles, tasks and processes of the management of people with disabilities by staff still has limitations, which are also related to difficulties, barriers and challenges originating from themselves, the policy mechanism, PWDs, families, communities and the facilities and units where they work. One of the outstanding difficulties and challenges is that the job position is unclear, part-time or multi-tasking as well as staff lacking professional capacity in the management of people with disabilities in the community.
The process of case management with PWDs in the community is influenced by many factors. The study discovered a model of strong influencing factors including 05 groups of factors with strong and very strong levels of influence affecting the effectiveness of case management with PWDs in the community, including: Awareness, participation of family and community; Strengths, capabilities of PWDs; Relevant legal policy system; Leadership and capacity of the facility; Professional capacity of case management staff. In which, the factors of professional capacity of case management staff proved to be the group of strongest influencing factors.
From the research results on the current situation of implementing case management with PWDs in the community, from the training needs and the current situation of the team, an experimental impact program including training courses and post-training supervision in improving the professional capacity of case management staff in the community was implemented. The results showed improvements based on self-assessment of participants and case observations expressed in terms of awareness, knowledge and confidence in performing the roles, tasks and skills of case management with PWDs. In addition, the post-training training measures showed that the trainees had positive changes in performing specific roles, tasks and activities when managing cases with PWDs in the community. Thus, the training measure combining training and guidance and supervision will bring about effectiveness in improving the capacity of the team implementing case management with PWDs in the community.
2. Proposed solutions
In theory and practice, PWDs are a specific group of customers, each individual has different characteristics and support needs, depending on the type of PWD, so the management of PWDs needs to be individualized and diversified. To increase the effectiveness and professionalism of management of PWDs in the community, a group of synchronous solutions from many aspects and related subjects is proposed.
2.1. Perfecting mechanisms and policies and increasing law enforcement capacity
- Circular 01/2015/TT-LDTBXH and Circular 02/2020/TT-LDTBXH of the Ministry of Labor, Invalids and Social Affairs on promulgating management of subjects including PWDs need to be studied for feasibility and practical application in localities to have appropriate adjustment and update directions. In addition, it is necessary to promote training instructions and supervision during the implementation process.
- Develop and promulgate regulations and procedures on interdisciplinary team coordination between health, education, justice, etc. departments, clearly defining the roles of relevant parties as well as identifying and affirming the role of team leader of the QTH staff so that they have a specific position in the implementation process.
- Integrate social work-oriented care management into national programs and policies and local programs and plans to promote this method not only in concentrated care facilities but also in the community.
- Continue to develop the network of collaborators, social workers, and social workers in both quantity and quality through human resource training and policy mechanisms to create important human resources to deploy social work services in general and to implement social management with people with disabilities in particular.
- It is necessary to develop appropriate policies and allowances for cadres, civil servants, social workers and collaborators working in social assistance for the disabled to attract a quality workforce.
- Create a socialization mechanism for non-public establishments to participate in providing public services, including quality management for people with disabilities with typical models.
2.2. Developing a network of facilities and service providers
- Develop diverse types of services to meet the needs of PWDs in the community through the internal resources of the facility and especially in the network connecting service providers.
- Link and form a network with available addresses, coordination processes, referrals, and responsible units from social welfare facilities, other social/work facilities, and local authorities to create a richer service resource locally. Focus on systematizing databases and promoting to increase access to information for people with disabilities and their families.
- Improve service quality through specialization of QMS activities through trained and specialized staff, support for each target group including PWDs and need to stabilize long-term job positions for the performers.
- Strengthen management through professionalization of case files, tools, forms and operational activities to professionalize support work to properly and adequately meet the needs of people with disabilities.
- Strengthen the service delivery network with the participation of many different types of facilities and support units outside the local government system and public facilities.
2.3. Improve the capacity of the team implementing QLTH with PWDs through specialized and appropriate training forms.and flexible
- Develop diverse training forms and training programs in coordination with service providers and support units according to labor market forecasts in the social service sector, according to national programs and projects, according to specific orders of localities such as short-term courses, longer-term programs to grant certificates and degrees in the direction of specialized training, creating specialized human resources.
- Promote training methods that combine theory, classroom practice and fieldwork at the facility. Build a system of local trainers with school experience to provide practical training and improve the capacity of the QMS implementation team.
- Increase the amount of practice time in training in addition to equipping knowledge, skills, and professional ethics in managing people with disabilities in the community.
- It is necessary to conduct training with interdisciplinary teams and teams (Labor, Invalids and Social Affairs officers, doctors, physiotherapists, judicial and educational officers, etc. at the local level) to create common understanding and consensus in operations.
2.5.Changing awareness, increasing participation of people with disabilities
- Promote consultation activities, create trust, motivation and explore the potential of people with disabilities.
- Changing awareness through training, communication about PWD rights, legal policies and equipping them with independent living skills and self-advocacy.
- Encourage participation and self-determination of people with disabilities when staff perform roles, tasks and activities in the case management process with people with disabilities in the community.
- Promote the establishment and maintenance of activities in teams and self-help clubs so that PWDs can share, encourage and support each other in life, creating consensus and a common voice for PWDs. QLTH staff plays the role of catalyst, supporting the process of establishing and operating groups.
2.6.Communicate, raise awareness and promote family and community involvement
- Extensively disseminate information about the rights of people with disabilities, the policy system, programs to support people with disabilities, community responsibilities, benefits to the community when people with disabilities' lives are improved and they have the opportunity to integrate into society, history and national values and community values when helping people in difficult circumstances, social support services, ways to help and communicate with people with disabilities in daily life in the community.
- Use various forms of propaganda and mobilization such as organizing competitions to learn about and award prizes related to specific topics; Connect with medical experts, rehabilitation, nutrition, psychological counseling in presentations, talks, training, community activities on prevention, early detection, early intervention, nutrition, self-care and support for people with disabilities; Use newspapers, radio, social media channels of resident groups and residential groups to share about the difficult circumstances of people with disabilities who need specific assistance in the area, set good examples of people with disabilities with strong will, set examples of role models in the community in supporting people with disabilities.
- Create conditions for community participation and the process of managing people with disabilities by applying the resource-based community development model to connect local resources in assisting people with disabilities and in the process of managing people with disabilities. Neighbors, friends in the same situation, family heads, etc. are both relevant subjects and natural, informal networks to support people with disabilities in many aspects of human resources, materials, relationships, and spiritual encouragement.
- Strengthening the capacity of family members to help them support people with disabilities to take care of themselves and live independently, while equipping them with skills to manage emotions, change perceptions, seek to identify abilities and strengths, increase participation, and respect the voice of family members with disabilities.
- Feedback and sharing of personal and family experiences in supporting PWDs in clubs, groups, and community activities is the best way to continuously improve services, change the culture in receiving social services, and how to access services and assistance. Members participating in groups can consult and connect with families in similar situations to share difficulties, increase the value of families in the community, and find appropriate and effective solutions for PWDs and family members.
3. Limitations of the Thesis
Within the scope and implementation capacity, the Thesis still has three major limitations:
The first, feedback channels, assessments from people with disabilities as service beneficiaries, support is still limited, mainly exploited from PVS. Therefore, self-assessment information of QLTH staff can still contain subjective elements. However, QLTH staff are the ones who directly implement, so their role is also very important and the research approaches from the perspective of the implementer to self-reflect and reflect on themselves first according to the principle of self-reflection in social work practice.Monday,The questionnaire survey method does not determine the total sample size and the position of the social work staff with PWDs in the community is still unclear, the level of professional training in social work and specifically in social work management of the respondents is not high, leading to some terms in the questionnaire may be unfamiliar. The influencing factors are assessed for their level of influence from the subjective perspective of the social work staff. The self-assessment of the respondents may increase or decrease when using the scoring method (Siemsen, Roth & Oliveira, 2010) or there are dishonest answers (Evans, 1985). Such limitations may affect reliability. The thesis also cannot establish a regression model to establish a causal relationship, thereby detecting strong influencing factors with more rigorous scientific nature. The online survey method can be affected by a number of factors such as the lack of people to guide the questionnaire or answer questions... However, thanks to this form, the survey area covers 23/24 districts and brings diversity from the organizations and units participating in the response. The survey of distributing questionnaires still accounts for the majority, ensuring control as well as support during the process of participants answering the questionnaire. In addition, the Thesis overcomes the limitations to some extent by using many qualitative research methods (in-depth interviews, group discussions, case observations, impact experiments with many groups of subjects) to be able to analyze, supplement, and compare.Tuesday,The impact experiment was short-term and could not be compared with the control group, so the reliability of the capacity building training measure for QLTH staff still has certain limitations. The results related to descriptive statistics with a small sample size have limited reliability (Gogtav, 2010). The thesis overcomes this by adding a qualitative research method (observing cases with 02 staff with different demographic characteristics, working in different types of units), verifying the changes in the practice of applying case management after the impact experiment.
LIST OF AUTHOR'S WORKS RELATED TO THE THESIS
Author:ussh
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